Before I get to the cost of a measles outbreak, I think Seth Mnookin sets the appropriate frame of reference:

I don’t know anyone in the world who likes needles or likes watching needles pierce their child’s skin. However, the fact that something is scary does not convey a license to blithely deny reality — which is why I find the actions of parents who have simply decided for themselves that vaccines and dangerous and at the same refuse to acknowledge the potential repercussions of not vaccinating on those around them to be morally repugnant….

If there’s one thing I hope I can accomplish in this debate, it’s showing parents the difference between verifiable, reliable data and anecdotal, fear-based myths — and, as I said, calling someone a total asshole is probably not the way to convince them to rely on evidence and not emotion. But I’ve spent too much time listening to the stories of people like Kelly Lacek (whose three-year-old spent four days in a medically-induced coma with Hib after her chiropractor convinced her not to vaccinate) and Danielle Romaguera (who held her seven-week old baby in her arms as she died as the result of a pertussis infection) and Toni and David McCaffery (whose four-week-old girl died of pertussis) to have much patience for parents who ignore the science supporting vaccines and also refuse to acknowledge the dangers of infectious diseases.

(Note to NatGeo: PLoS apparently lets its blogger call people assholes. Just saying).

Stopping the measles virus before it can cause serious disease — and by “serious,” I mean deafness, pneumonia, encephalitis and miscarriage — is incredibly costly and labor-intensive. An account published overnight in the Journal of Infectious Diseases gives a glimpse at just how costly. To stop a 14-person outbreak that began with one unvaccinated tourist visiting a US emergency room, the Arizona Department of Health had to track down and interview 8,321 people; seven Tucson hospitals had to furlough staff members for a combined 15,120 work-hours; and two hospitals where patients were admitted spent $799,136 to contain the disease….

But what this Arizona outbreak makes clear is how many more people are forced to assume that risk without being consulted: not only the infants, elderly and immune-compromised among those 8,321 people exposed in this outbreak, but the hospital shareholders and taxpayers who paid the bill for it to be contained. Until we start counting up those costs as well, we won’t achieve an honest accounting of vaccine refusal’s true price.

Assholes. But there’s another group of assholes that play a role–unvaccinated healthcare workers:

There’s an important dimension to this outbreak that may not be evident at first. We tend to blame parents who hold their kids back from vaccination for breaches in the wall of herd immunity. But the people who were infected in this outbreak and shared responsibility for passing it on included adult health care workers who had never been vaccinated and who had missed or declined the chance to get booster shots. By doing that, they put their unknowing patients at risk — and infected, among others, someone with brain cancer and another person living with Down syndrome.

When the hospitals checked to see who among their staff wasn’t vaccinated, they found that 30 percent didn’t know or couldn’t prove it. The two hospitals where measles patients were cared for actually did blood tests on their staff, and found that 9 percent were non-immune: never-vaccinated, never-infected. If the hospitals had not acted to identify those employees and send them home or vaccinate them, they could have hosted a roaring epidemic that might have been impossible to contain.

In the past, I’ve been more lenient in my attitudes towards this problem, but the more I think about it, the more I realize I was wrong: unless there is a medical reason (e.g., allergies), healthcare workers–and not just those at hospitals–should be vaccinated. There’s no constitutional right to work in a hospital.

I absolutely agree that health care workers should be vaccinated, but my one quibble is the ability to prove it. How many of us can prove we were vaccinated as kids or even can prove that we’ve gotten our boosters!

I remember getting an MMR booster my freshman year in college, but since that was ::mumblecoughmumble:: a few years ago, I can’t prove that.

So how do we solve this? Do we have to check the immunity status of every health care worker by blood test? Do we have to trust they’ll remember correctly and report correctly on their immunization status?

(And how often do we need an MMR booster anyway? I got a DTaP booster about 4 years ago, but the MMR was, um, more like 20. Ish.)

A simple blood test for titers to rubella, mumps and measles can be done. It will show if a person is immune or not. It’s very common for healthcare employers to require proof of immunity before hiring, at least in NYC.

Blood tests would be a good idea anyway: I was vaccinated as a child, but the vaccine had been poorly stored and I caught measles anyway.

I think the reason you don’t get re-vaccinated for measles is something to do with it being viral, and DTaP being for bacterial diseases, but I don’t know any of the details of why! (Also, here in the UK, you don’t get boosters for tetanus after your teens, even if you’re at risk of exposure. Is this a cost-saving thing?)